Skip to main content
SpringerLink
Log in

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The main goal in treatment of ductal carcinoma-in-situ (DCIS) of the breast is to prevent local recurrences. Radiotherapy after breast-conserving surgery has been shown to decrease the recurrence rate, although whether all patients should be treated with radiotherapy remains a topic of debate. The aim of this study was to assess the local recurrence rate after conservative surgical treatment of DCIS without radiotherapy and to identify risk factors for local recurrence.

Methods

A total of 499 female patients with 502 DCIS lesions treated in the period 1989 to 2002 were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method, and differences were tested by using the log-rank test. The association of variables with local recurrence was analyzed by using the χ2 test.

Results

Treatment constituted of lumpectomy in 329 patients (65%). Thirty-eight patients (8%) had disease-positive margins, and for 41 patients (8%) the margin status was not known. Eighty tumors recurred, for a local recurrence rate of 13% after 4 years compared with 17% for patients treated with breast-conserving surgery only. Risk factors for ipsilateral recurrences were younger age (<50 years), treatment with breast-conserving surgery only, and presence of disease-involved surgical margins.

Conclusions

Conservative treatment of DCIS results in high recurrences rates, and outcomes can be improved by performing more radical surgery. Because radiotherapy has been shown to be effective in preventing recurrent disease, and, to date, no subgroups have been identified in which radiation can be omitted, its use is recommended, especially in younger patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004;96:443–8

    PubMed  Google Scholar 

  2. Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI. Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22-25, 1999. Cancer 2000;15:946–54

    Article  Google Scholar 

  3. Silverstein MJ, Barth A, Poller DN, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer 1995;31A:1425–7

    Article  PubMed  CAS  Google Scholar 

  4. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–41

    Article  PubMed  Google Scholar 

  5. Morrow M, Strom EA, Bassett LW, et al. Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin 2002;52:256–76

    Article  PubMed  Google Scholar 

  6. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma of the breast. JAMA 1996;275:913–8

    Article  PubMed  CAS  Google Scholar 

  7. Ottesen GL, Graversen HP, Blichert-Toft M, Christensen IJ, Andersen JA. Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study. Breast Cancer Res Treat 2000;62:197–210

    Article  PubMed  CAS  Google Scholar 

  8. Page DL, Dupont WD, Rogers WL, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15-25 years after diagnosis of low grade ductal carcinoma in situ of the breast treated only with biopsy. Cancer 1995;76:1197–200

    PubMed  CAS  Google Scholar 

  9. Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 2001;91:1090–7

    Article  PubMed  CAS  Google Scholar 

  10. Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 2004;96:1311–21

    Article  PubMed  Google Scholar 

  11. Silverstein MJ. The University of Southern California/Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg 2003;186:337–43

    Article  PubMed  Google Scholar 

  12. Boyages J, Delaney D, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ. Cancer 1999;85:616–28

    Article  PubMed  CAS  Google Scholar 

  13. Vicini FA, Goldstein NS, Kestin LL. Pathologic and technical considerations in the treatment of ductal carcinoma in situ of the breast with lumpectomy and radiation therapy. Ann Oncol 1999;10:883–90

    Article  PubMed  CAS  Google Scholar 

  14. Waldman F, DeVries S, Chew KL, Moore DH, Kerlikowske K, Ljung B-M. Chromosomal alterations in ductal carcinomas in situ and their in situ recurrences. J Natl Cancer Inst 2000;92:313–20

    Article  PubMed  CAS  Google Scholar 

  15. Cataliotti L, Distante V, Ciatto S, et al. Intraductal breast cancer: review of 183 consecutive cases. Eur J Cancer 1992:28A:917–20

    Article  PubMed  CAS  Google Scholar 

  16. Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993;328:1581–6

    Article  PubMed  CAS  Google Scholar 

  17. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441–52

    PubMed  CAS  Google Scholar 

  18. Fisher ER, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight year update of protocol B-17. Cancer 1999;86:429–38

    Article  PubMed  CAS  Google Scholar 

  19. Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Lancet 2000;355:528–33

    Article  PubMed  CAS  Google Scholar 

  20. Bijker N, Peterse JL, Duchateau L, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;22:63–71

    Google Scholar 

  21. Bijker N, Peterse JL, Fentiman IS, et al. Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS. Br J Cancer 2002;87:615–20

    Article  PubMed  CAS  Google Scholar 

  22. Silverstein MJ, Gierson ED, Colburn WJ, et al. Can intraductal breast carcinoma be excised completely by local excision? Cancer 1994;73:2985–9

    PubMed  CAS  Google Scholar 

  23. Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455–61

    Article  PubMed  CAS  Google Scholar 

  24. Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer 2001;91:9–16

    Article  PubMed  CAS  Google Scholar 

  25. Kuske RR, Bean JM, Garcia DM, et al. Breast conservation therapy for intraductal carcinoma of the breast. Int J Radiat Oncol Biol Phys 1993;26:391–6

    PubMed  CAS  Google Scholar 

  26. Sneige N, McNeese MD, Atkinson EN, et al. Ductal carcinoma in situ treated with lumpectomy and irradiation: histopathological analysis of 49 specimens with emphasis on risk factors and long term results. Hum Pathol 1995;26:642–9

    Article  PubMed  CAS  Google Scholar 

  27. Bonnier P, Body G, Bessenay F, et al. Prognostic factors in ductal carcinoma in situ of the breast: results of a retrospective study of 575 cases. Eur J Obstet Gynecol Reprod Biol 1999;84:27–35

    Article  PubMed  CAS  Google Scholar 

  28. Ringberg A, Idvall I, Ferno M, et al. Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast. Eur J Surg Oncol 2000;26:444–51

    Article  PubMed  CAS  Google Scholar 

  29. Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BC. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys 2002;54:1331–5

    Article  PubMed  Google Scholar 

  30. Holland R, Hendriks JHCL, Verbeek ALM, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 1990;335:519–22

    Article  PubMed  CAS  Google Scholar 

  31. Faverly DRG, Burgers L, Bult P, Holland R. Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications. Semin Diagn Pathol 1994;11:193–8

    PubMed  CAS  Google Scholar 

  32. Mai KT, Yazdi HM, Burn BF, Perkins DG. Pattern of distribution of intraductal and infiltrating carcinoma: a three-dimensional study using serial coronal giant sections of the breast. Hum Pathol 2000;31:464–74

    Article  PubMed  CAS  Google Scholar 

  33. Elkhuizen PHM, Van de Vijver MJ, Hermans J, et al. Local recurrence after breast-conserving therapy for invasive breast cancer: high incidence in young patients and association with poor survival. Int J Radiat Oncol Biol Phys 1998;40:859–67

    Article  PubMed  CAS  Google Scholar 

  34. Zee Van KJ, Liberman L, Samli B, et al. Long term follow-up of women with ductal carcinoma in situ treated with breast conserving surgery. Cancer 1999;86:1757–67

    Article  PubMed  CAS  Google Scholar 

  35. Kestin LL, Goldstein NS, Lacerna MD, et al. Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy. Cancer 2000;88:596–607

    Article  PubMed  CAS  Google Scholar 

  36. Kestin LL, Goldstein NS, Martinez AA, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy. Ann Surg 2000;231:235–45

    Article  PubMed  CAS  Google Scholar 

  37. Solin LJ, Fourquet A, Vicini FA, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status. Int J Radiat Oncol Biol Phys 2001;50:991–1002

    Article  PubMed  CAS  Google Scholar 

  38. Cutuli B, Cohen-Solal-Le Nir C, De Lafontan B, et al. Breast conserving therapy for ductal carcinoma in situ of the breast: the French cancer centers’ experience. Int J Radiat Oncol Biol Phys 2002;53:868–79

    Article  PubMed  Google Scholar 

  39. Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992;10:356–63

    PubMed  CAS  Google Scholar 

  40. Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pattinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Surg Oncol 2001;76:245–54

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands

    Arjan P. Schouten van der Velden MD & Adriaan Hennipman MD, PhD

  2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands

    Petra H. M. Peeters MD, PhD

  3. Comprehensive Cancer Centre Middle Netherlands, P.O. Box 19079, 3501, DB, Utrecht, The Netherlands

    Veronica C. M. Koot MD, PhD

Authors
  1. Arjan P. Schouten van der Velden MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Petra H. M. Peeters MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica C. M. Koot MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adriaan Hennipman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adriaan Hennipman MD, PhD.

APPENDIX 1.

APPENDIX 1.

Members of the Comprehensive Cancer Centre Middle Netherlands Surgical Oncology Group

Members of the Comprehensive Cancer Centre Middle Netherlands Surgical Oncology Group (listed alphabetically): R. Koelemeij, MD, PhD, St. Anthonius Ziekenhuis, Nieuwegein; C. Perre, MD, PhD, Diakonessehuis, Utrecht and Zeist; J. Rütter, MD, PhD, Rivierenland Ziekenhuis, Tiel; E. Theunissen, MD, PhD, Mesos Utrecht, Utrecht; H. Vente, MD, PhD, Hofpoort Ziekenhuis, Woerden; and G. Verberne, MD, PhD, Meander Medisch Centrum, Amersfoort.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Velden, A.P.S., Peeters, P.H.M., Koot, V.C.M. et al. Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age. Ann Surg Oncol 13, 990–998 (2006). https://doi.org/10.1245/ASO.2006.05.044

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.05.044

Keywords

Search

Navigation